Mount Sinai West

There is a significant need for trials that evaluate the treatment of University of Texas (UT) grade 2 and 3 diabetic foot ulcers (bone, joint, or tendon exposed wounds). We undertook a trial looking at the effect of intact fish skin graft (IFSG) on these deep and difficult-to-heal ulcers. 262 patients Intent to Treat (ITT) patients with UT grade 2 and 3 DFUs were randomised to receive intact fish skin graft (IFSG) or a standardised treatment (SOC) that adhered to the International Working Group on the Diabetic Foot (IWGDF) guidelines. The secondary endpoints that were measured included wound area reduction (WAR), healing rates at 20 and 24 weeks; closure rates by UT grade, perfusion, quality of life, pain reduction and IFSG safety. We report ITT (all randomised) (mITT previosly reported) The (WAR) at 12 weeks was 65.53% for IFSG versus 30.82% for SOC (p = 0.007). UT 2 wounds (60% of total) exhibited a closure rate of 47% versus 23% at 16 weeks for IFSG versus SOC (p = 0.0033). Target wound infections were comparable (39 vs. 37) and major outcomes were comparable during the 24 week period (target-limb amputations 8% vs. 7%). Time-to-heal favoured IFSG (restricted mean to 24 weeks 17.31 vs. 19.37 weeks; KM/log-rank significant; Cox HR 1.59). The in the treatment of deep complex diabetic foot wounds the addition of IFSG significantly improved the number of patients with total wound closure as well as the time to wound closure without increased risk of complications. This improvement in total wound closure and time to wound closure was noted across prior amputation status, quality of perfusion, and UT grade.

Persistent ileal ulcerations in Crohn's disease (CD) typically suggest refractory inflammation, yet rare fungal infections may coexist silently. We report a 22-year-old immunocompetent man with CD and seronegative spondyloarthritis who achieved clinical remission on ustekinumab but exhibited persistent ileal ulcerations. Repeat biopsies revealed Histoplasma spp . on Periodic Acid–Schiff staining, confirming intestinal histoplasmosis without pulmonary involvement. Dual pathology required continuation of ustekinumab and initiation of itraconazole. This case highlights the importance of considering fungal infections when endoscopic healing fails despite clinical response.

Accurate staging of breast cancer (BC) is essential for guiding treatment decisions and estimating prognosis. Current guidelines discourage routine diagnostic imaging in asymptomatic patients. However, adherence is often inconsistent in clinical practice. In Latin America (LATAM), this is further challenged by higher rates of advanced-stage presentations and aggressive tumor subtypes, which may lead to more frequent imaging. Yet, there is a lack of data on real-world imaging patterns in the region. Understanding current staging practices is critical to identifying care gaps, informing context-appropriate guidelines, and promoting efficient diagnostic strategies. We conducted a cross-sectional, anonymous online survey among oncologists and breast surgeons from LATAM countries. The survey included 63 items covering sociodemographic characteristics, imaging use by clinical stage, decision-making criteria, access to diagnostic technologies, turnaround times, and familiarity with guidelines. Descriptive statistics were used for analysis. A total of 269 physicians participated. Respondents included physicians from 18 LATAM countries and Spain; 55.4% were oncologists and 44.6% breast surgeons; 57.3% worked primarily in public settings, and 55.4% had over 10 years of experience. While 43.5% managed more than 50 BC patients per month, only 18.2% were exclusively dedicated to BC care. Guideline awareness was high (NCCN: 89%, ESMO: 71.4%, national: 70.6%), and 89.1% stated that guideline recommendations were important for decision making in clinical practice. Despite this, routine use of diagnostic imaging was reported in 34.2% of asymptomatic patients with stage I disease, 48% in stage II without nodal involvement, 77.7% in stage II with nodal involvement, and 91.1% in stage III. Chest CT (65.9%), abdominal CT (63.2%), and bone scintigraphy (62.7%) were reported as the most frequently used studies, though abdominal ultrasound (US) (42.2%), chest X-ray (40.9%), and PET-CT (23.3%) were also reported. Imaging decisions were primarily influenced by tumor size (78.3%) and biological subtype (65.9%). Chest X-ray and abdominal US reported use decreased from 62.8% in stage I to 24.7% in stage III patients, while thoraco-abdominal CT use increased from 36.2% in stage I to 85.7% in stage III patients. The reported use of imaging did not change based on medical specialty or years of clinical practice. Access to advanced imaging modalities such as PET-CT was more restricted; only 43.9% had consistent availability, and 44.6% reported turnaround times >4 weeks, compared to <3% for chest X-ray or abdominal US, 15.9% for thoraco-abdominal CT, and 27.1% for bone scintigraphy. Most respondents (62.5%) indicated that imaging decisions and turnaround times (82.2%) would differ based on patients' insurance status (public vs private). Overall, the findings highlight a disconnect between guideline-based recommendations and real-world practice, shaped by system-level disparities and resource constraints. Our findings underscore a significant gap between guideline recommendations and real-world diagnostic imaging practices for BC staging across LATAM. Despite high awareness of guidelines, the frequent use of imaging reflects inconsistent adherence to guideline recommendations. Early-stage patients often undergo extensive imaging, with limited access and long delays—particularly for advanced modalities like PET-CT— that may contribute to treatment delays. These findings support the need for regionally adapted staging guidelines and targeted educational strategies to improve guideline-concordant care across LATAM. This work was conducted with the collaboration of LABCA, ACHO, ACM and SVM. W. A. Mantilla, M. A. Bravo, V. Acosta-Marín, A. M. Osorio, C. Villarreal-Garza, A. W. Mushtaq, F. E. Petracci, S. Cervera, G. Santander, A. Reyes-Morales, D. U. Landaverde, J. C. Samamé-Pérez-Vargas, J. Moreno-Rios, L. Gutiérrez, B. Moreno-Jaime, J. J. Caicedo, S. Quintero, A. M. Mejía, H. Carranza, S. X. Franco. Real-world patterns and preferences in the use of diagnostic imaging for breast cancer staging in Hispano-America: A multinational physician survey [abstract]. In: Proceedings of the San Antonio Breast Cancer Symposium 2025; 2025 Dec 9-12; San Antonio, TX. Philadelphia (PA): AACR; Clin Cancer Res 2026;32(4 Suppl):Abstract nr PS5-10-21.